Moving us from the absence of harm, to the presence of safety

‘Integration and learning’ is fundamental to our pursuit of quality improvement and patient safety. If we are to improve we must develop our wherewithal to learn. No easy task when preoccupied with extinguishing fires!

The purpose of any framework I guess is to help in some way to order thinking. A helping hand to make it more likely we achieve what we are striving for. The Health Foundation’s framework for the measurement and monitoring of safety offers just that. A guide to nurture our understanding of patient safety and to help us consider the broader range of information we need to establish not only whether care has been safe in the past but also if care will be safe today and in the future.​Data, or rather ‘information’ is needed to enable intelligent decision making. To intervene or not?, to change or stick?, to escalate or not? Used appropriately it is our unit of learning. Measuring is the process of accumulating information. Monitoring is keeping a check on those measurements over time looking for deviation or variation that might require deeper understanding, and learning.

Figure 1

The ‘integration and learning cycle’ (Figure 1) is intended to illustrate the passage of information through an organisation. Considering the passage of information it is perhaps easy to recognise some of the common ‘operational frailties’ that can disable organisational thought processes, undermine intelligent decision making and ultimately impede learning. It matters ‘not a jot’ what information or data you have, if you lack the operational maturity to learn from it.

​

Used alongside the other domains of the framework (Figure 2), it should encourage a reflection of current practice and help you fully consider the integration and learning domain in order to answer the question ‘are we responding and improving’, or more simply ‘are we learning?’

Figure 2

Proposed are a series of questions intended to illustrate some of the common operational weak points where focus on improvement will likely improve your ability to learn (Table 1).

How well we manage this passage of information impacts significantly on our sense of purpose, achievement and satisfaction. It will also impact upon our organisational relationships and morale and importantly how burdensome scrutiny and assurance become.

Put simply if business as usual is chaotic with multiple deficiencies in the passage of information required for learning i.e. you are ‘operationally frail’ - it follows that life will be uncomfortable for those attempting to create (or portray) order or improvement. Scrutiny will carry a heavy burden and assurance will be difficult to provide. In contrast, if business as usual is highly organised, then learning and improvement will come easier, assurance will be relatively easy to provide and scrutiny welcomed not feared. Easy right!